Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Without insurance, the 64-year-old auto-mechanic counted on the visits to stay healthy so he could support his two sons, three stepchildren and three nephews by working seven days a week.

But one night last year, just after Thanksgiving, Castell awoke in a drenching sweat, too dizzy to even stand up. His blood sugar had plummeted and he lapsed into a diabetic shock.

Because he didn’t have insurance, the local emergency room sent Castell 90 miles away to another hospital, where he eventually stayed 10 days. He received in-home nursing care for three more months, ringing up $60,000 in bills he cannot pay.

Castell, who recently turned 65, now has coverage under Medicare and tests his blood sugar daily with a portable monitor — something he says could have prevented his earlier crisis.

“I was getting pills, but I never took insulin shots,” he said. “They never gave me a monitor. They just told me take more pills, take this pill, take that pill.”

Unhealthy numbersAccording to a recent study by UCLA’s Center for Public Policy, the state’s Hispanic elderly reported that they are less healthy and have less access to basic preventive health care than whites in their age group.

Nearly 45 percent of Hispanic seniors said they were in poor or fair health, while nearly 50 percent had never been screened for colon cancer and 45 percent hadn’t had a flu shot in the past year.

Asians and blacks also reported receiving less preventive care than whites in their age group. About four in 10 respondents in the black and Asian categories said they were in poor or fair health.

In contrast, only one-quarter of white seniors considered themselves unhealthy and two-thirds reported receiving flu shots and colon cancer screening.

The Oct. 28 study used 10,000 responses from the 2001 California Health Interview Survey and 2000 U.S. Census data to compile information about the health practices of older Californians, broken down by race, economic status and amount of insurance coverage.

Dr. Steven Wallace, the study’s lead author, said he wasn’t surprised to find that Hispanic seniors and those with limited English received far less preventive health care.

Many Hispanic seniors don’t seek out free flu shots, annual exams and diabetes screening because they don’t speak fluent English, don’t have insurance or don’t believe the services are intended for them, said Wallace, associate director of UCLA’s Center for Public Policy.

“Latinos consistently showed the worst pattern of access to health services,” he said. “A lot of the data that came out really showed the importance of trying to improve the access to care.”

Study's findings are consistent
Black and Asian seniors reported similar health care experiences, although Asians were more likely to get flu shots than other minority groups.

Nearly 50 percent of Asian seniors had never had a colonoscopy, but 73 percent reported getting a flu shot in the past year. More black elderly had undergone a colonoscopy — 62 percent — but nearly half hadn’t had a flu shot in the past year.

Chang Wei Fun, an 85-year-old Taiwanese woman, doesn’t have prescription coverage through Medicare and spends $600 every two months on medicine for heart problems and diabetes. She said she dreads going to the doctor because she’s intimidated.

Public health officials said the study’s findings were consistent with their observations.

John Jennings, a public health nurse for Los Angeles County, said workers from his clinics waited outside drug stores, churches and community centers this fall to give the elderly and uninsured flu shots.

“We’ve tried to focus more in on the uninsured in recent years and we’re trying new ways (to reach out) in minority communities,” he said. “We have such a huge underinsured population.”

UCLA has no plans to conduct similar studies in other states, Wallace said, because the report was based on a special California health survey designed to give county-level health data, which is not available in most other states.